Permit I
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
IN a ' COMMUNITY DEVELOPMENT Permit #: ELR2013 -00120
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 06/03/2013
Parcel: 1 S135AB01003
Jurisdiction: TIGARD
Site address: 10300 SW GREENBURG RD 220
Project: Kelly Services Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Data telecommunications system.
Contractor: LAN TEL SERVICES INC Owner: LINCOLN CENTER LLC
204 -A JEFFERSON ST BY SHORENSTEIN PROPERTIES LLC
EUGENE, OR 97402 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE 541- 688 -1427 PHONE:
FAX 541 - 688 -4642
FEES
Description Date Amount
Specifics: , Restricted Energy Permit 06/03/2013 $75.00
12% State Surcharge - Electrical 06/03/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC N Instrumentation N
Intercom/Paging. N Landscape /Irngation N
Landscape Lighting: N Medical' N
Nurse Calls' N Protective Signal: N
Security Alarm. N Other: N Total $84.00
Other Desc. Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952- 001 -0090 You may obtain a copy of the s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B • Permittee Signature:
,........_____5_ .-
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
This permit card shall be kept In a conspicuous place on the job site until completion of the project
Approved plans are required on the Job site at the time of each Inspection.
APR-16-2009 1.0:21 From: To:15035981960 Page:1'3
Electrical Permit ApplicatioltEr
EIVED FOR OFFICE USE ONLY
City of Tigard Received
Date/13 Pen= No . 6 i_ }.0 1 .-. ,j ,..,
II • 13125 SW Hall Blvd„ Tigard. OR 9722P AY 2 9 2013
Plan Review
a Phone: 503.718.2439 Fax: 503 598.1960 ART) Date/B . Other Permit. a
• • . —
• 7
T G A R
Inspection Line: 503.639.4175 CITY
1 0 OF l= . 7 , Page 2 for
RIIILD
Internet; onvw tigard-or.gov 1NL G pat
D Notified/Method: : Supplemental Informodon
10k.g "-=e- '•-•? OAEY0: :', •'. :;* l...'
t , -, Z1 7.; • ..,r,
0 New construction 0 Addition/alteration/replacement Please check ill that apply (submit I sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over tbree stones,
El Demolition 0 Other: where the available fault current 0 Marinas and boatyards
- r: ._ •.:'-:,:::`: ',"`::. '..--: : excee !coop amps at ISO vo or 0 floating buildings
i.:',5:..ZZ>.:::•AS.: glitX Pr' ‘C1:6%, PIQ.N • , :;,•:..-..:: ..`:•..:....::z -.., -, :',1::. ,.:- len to ground, or euetels 14,000 0 Commercial-use agricultural
0 1- and 2-family dwelling NCommercial/industrial El Accessory building amps for all other installations buildings.
0 Multi El Master builder 0 Other: 0 Fire pump. 0 liniallanon of 150 KVA or
' '.ii : ''.--:::'''-. r: ? :' ..,-,,,,,,,,,,' ;,; "*' 13 Emergency 'YF larger separately derived system.
- ,„.„.... ;, ,. a • . , ." • ' • ' , • . ,, .' I ": .--".• .---: '''"7 :, .•': ID Addition of new motor load of 0 "A"."E", "1-2", "1-3",
Job no.: Job site address: /0300 Siil 6 ta4 /wire f 41 SUlte,224 00HP or more.
0 Six or more residenbal units 0 occupancy
Recreational vehicle parks.
City/State/ZIP: -- Ariloyd Ok 1/?Z23 0 Heahh-care facihues 0 Supply voltage for more than
i 0 Hazirdous locations. 600 volts nominal.
Suite/bldg./apt. no.: 2:2./, Project name: 14, &Mac IA 6 -on C] Service or feeder 600 amps or more
):X-z .0F,; tlfriollUE , jt,;',P....3',:%%:v.:1 .;.•
Cross street/directions to job site: Description l_qty. I Fee. 3 Total i •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 168.54 4
Ea. add'! 500 sq. ft. or portion 33 92 i
Tax map/parcel no.: Limited - energy, residential
75 00 2
i„aii -i. 2, ' ' -70 7 •• ?7": with above sq. ft.)
Limited energy, multi-family
i fid 1.16 Hale. obi li 1 1 • residential (wrth above sq. fi.) 75.00 2
f : ', t3 ;Se i Pagi 2' r••',.:", .; •
(,4007 Services or feeders installation, alteration, and/or relocation _
' .: '-'- ' . -, •12r'sT-.40Pk.ktiV0 ' .;•;.! ';--:: ' 7. 2043 arni35 " icss 100.70 2
"- 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552 26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 59 36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125 08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
401 amps to 599 amps 168.54 . 2
Owner signature: Date: Branch circuits- new, alteration, or extension, Qer_panel
-.. "s" "." - - :. •-••• •::-';''.:EV.Ap.ikiliri,;:. .:::,:,.] j..g-,....:4--..::t:-'4::::::.::'‘'.7..:..-Cidt.liii-ikiii.4-41...-•:,_,c-;;-i-7: A. Fee for branch circuit with
' • .., - ..... • .: - .- -,-- 2 - •&4..: • . • . . — • P ,, = above service or feeder fee,
7A2 2
Business name: each branch circuit
B Pee for branch circuits without
Contact name: service or feeder fee, first
56.18 2
branch circuit
Address: Each add'I branch circuit 7.42 i I 2
Aliscellaneous (service or feeder not included)
City/State/ZIP.
Each manufactured or modular 67.84 2
Phone: ( ) Fax: : ( ) dwelling. service and/or feeder
Reconnect only 67.84 2
E Pump or tmgation circle 67.84 2
- ,,,. .... •;, ..:„._ s ,,. ...,:.: ; •,: : - .:::.:',.r.-..• - •••.e . .•-,.....: • .•.. 4...7....<; ,•.;IV: : Sign or outline lighting 67 84 2
Business name: i 7 &Anus . Signal circuit(s) or limited-energy i See ... 00
panel, alteration. or extension t Page 2 i 2
Address: pi.- A je1k,4 SI- Each additional inspection over allowable in any of the above
• ' Additional inspection (1 hr mm) 66.25/ hr
City/State/ZIP: gtqtylt.. e X 1774407_ investigation (1 hr min) 66.25/ hr
Phone: (5 i ) (ore - / Fax: (8-i i ) toff -4 6, 10-- Industrial plant (I hr mm) 78.18/ hr
Inspections for which no fee is 90 00/ hr
g k CCB Lie.. .. I Electrical Lic.: 0,tr , •I Suprv. Lic.: Vgaz ; 1 i 60 specifically listed (A hr mat)
,'
.-ipalks Suprv. Electrician sign ure, required: e------- 7s IC i/ - - • •-- ---
7 Subtotal: 7 s--, 1.- ---"---
Plan revicw (25% of permit fee):
Print name: .--77/ ‘ Date: Vzqii 2
— — State surcharge (12% of permit fee): (too
Authorized signature:,, 1 9g Am tpA)44,__., TOTAL PERMIT FEE: gy, 00
application expires if a permit is not obtained within 180
Print name: Tammy ` 4 I Date: W This permit 2g/13 days after it bas been accepted as complete_
• Number of inspections allowed per permit.
I t5undingtPerroits1ELC_PemutApp_ELkeitadoc Rev 052 If2013 440.4615T(1 00S/COMAYEA
APR - 16 -2009 10:22 From: To:15035981960 Pa9e•2
Electrical Permit Application — City of Tigard
Page 2 — Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
"��-'' ": _ _ �_•�•' �r•� • >: -- "mac -s �<.�.,�. - :.,,
Fee for all .......
residential systems combined. $75.00 Qty. - I'm Total •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems*
15.01 to 25 kva 200.34 2
CI Burglar Alarm Wind generation systems in excess of 2 lora:
25.01 to SO kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 Iva 552.26 2
>100 kva (fee in accordance with 352.26 2
❑ Heating, Ventilation and Air Conditioning OAR 918-309-0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7 42 3
❑ Vacuum Systems* >IOO - noadditionalcharge 00 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is
charged at an hourly (I hr min) 66.25/ hr 1
Inspections for which no fee is 90 OO/ In
specifically listed (V hr min)
. _CIr «K .fak .: _ tiS ;FEES•. , ... .
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918- 309 -0000) Plan review, if required (25% of permit fee):
State surcharge (12% of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within ISO
❑ Audio and Stereo Systems days after it has been accepted as complete.
Number of inspections allowed per permit
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 18wldutsPermrtilEll .C PemmApp Ft.a Rcv05/21/2013